Kobayashi Mariko, Akuta Norio, Suzuki Fumitaka, Suzuki Yoshiyuki, Arase Yasuji, Ikeda Kenji, Hosaka Tetsuya, Saitoh Satoshi, Kobayashi Masahiro, Someya Takashi, Sato Junko, Watabiki Sachiyo, Miyakawa Yuzo, Kumada Hiromitsu
Research Institute for Hepatology, Toranomon Hospital, Tokyo, Japan.
J Med Virol. 2006 Jan;78(1):60-7. doi: 10.1002/jmv.20504.
In a single hospital in Tokyo, the 87 patients infected persistently with hepatitis B virus (HBV) genotype A, the 413 with B, and the 3,389 with C were compared for virological outcome. Hepatitis B surface antigen (HBsAg) was cleared from the serum in 12% (3/26), 2% (2/112), and 3% (23/826) of patients with genotypes A, B, and C, respectively, at 5 years of follow-up (P = 0.0395). Hepatitis B e antigen (HBeAg) was cleared from serum more frequently in patients with genotype B than those with A or C (78% [32/41] vs. 58% [11/19] or 45% [251/562], P = 0.00001) at 5 years. Of the 45 individuals infected with genotype A and followed for 3 years or longer, HBeAg was more frequent (16% [3/19] vs. 73% [19/26], P = 0.0002) and levels of HBV DNA higher (median <2.6 [range: <2.6-5.6] vs. >7.6 [<2.6->7.6] log copies/ml, P = 0.001) in the 26 patients with biopsy-proven chronic hepatitis than the 19 asymptomatic carriers. Among the 26 hepatitis patients infected with HBV genotype A, decreases in HBV DNA were less frequent (20% [1/5] vs. 93% [13/14] or 86% [6/7], P = 0.0095) and increases in serum levels of hyaluronic acid > or =10 ng/ml commoner (80% [4/5] vs. 14% [2/14] or 14% [1/7], P = 0.017) in the patients who kept HBeAg than in those who seroconverted or who remained HBeAg-negative. In conclusion, patients persistently infected with HBV genotype A fare better than those with genotype B or C. However, high levels of HBV DNA continue in those in whom HBeAg persists along with fibrosis in the liver.
在东京的一家医院，对持续感染乙型肝炎病毒（HBV）A基因型的87例患者、B基因型的413例患者和C基因型的3389例患者的病毒学转归进行了比较。在随访5年时，A、B、C基因型患者血清中乙肝表面抗原（HBsAg）清除率分别为12%（3/26）、2%（2/112）和3%（23/826）（P = 0.0395）。随访5年时，B基因型患者血清中乙肝e抗原（HBeAg）清除率高于A或C基因型患者（78%[32/41]对58%[11/19]或45%[251/562]，P = 0.00001）。在45例感染A基因型且随访3年或更长时间的患者中，经活检证实为慢性肝炎的26例患者中HBeAg清除率更高（16%[3/19]对73%[19/26]，P = 0.0002），HBV DNA水平更高（中位数<2.6[范围：<2.6 - 5.6]对>7.6 [<2.6 ->7.6] log拷贝/ml，P = 0.001），高于19例无症状携带者。在26例感染HBV A基因型的肝炎患者中，HBeAg持续阳性的患者中HBV DNA下降频率较低（20%[1/5]对93%[13/14]或86%[6/7]，P = 0.0095），血清透明质酸水平≥10 ng/ml升高更为常见（80%[4/5]对14%[2/14]或14%[1/7]，P = 0.017），高于HBeAg血清学转换或HBeAg阴性的患者。总之，持续感染HBV A基因型的患者比B或C基因型患者预后更好。然而，HBeAg持续阳性且伴有肝纤维化的患者中HBV DNA水平仍然较高。
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